Report outlines path to halve premature deaths by 2050

Since 1970, 37 countries have cut the probability of their citizens dying before they reach age 70 in half, a milestone that signals the remarkable progress many countries have made in preventing and treating disease. But a new report argues that this goal isn't out of reach for any country that chooses to cut its premature mortality, even those afflicted by war or poverty.

The report, published Oct. 14 by The Lancet Commission on Investing in Health, lays out a roadmap for every nation that chooses to do so to cut the chance of premature death for its citizens in half by 2050. This goal, which the commission calls "50 by 50," is achievable, argues the report, through a series of targeted health investments, such as expanding childhood immunizations and low-cost prevention and treatments for common causes of preventable death, combined with scaling up financing to develop new health technologies.

"Today, the case is better than ever for going for mortality reduction," says Gavin Yamey, M.D., director of the Duke University Center for Policy Impact in Global Health (CPIGH), who led the writing of the commission report. "It's a prize within reach. It will have extraordinary health, welfare and economic benefits. Reaching '50 by 50' would reduce mortality and morbidity, help grow economies and alleviate poverties."

The Global Health 2050 report, which will be launched this week at the World Health Summit in Berlin, argues that countries should prioritize the 15 health conditions that cause most premature deaths. These include infectious diseases such as tuberculosis and respiratory infections, non-communicable diseases such as diabetes and cardiovascular disease, and other issues such as accidents and suicide. Most of the gains in global life expectancy over the past two decades are attributable to reductions in mortality from these conditions, according to the report.

However, millions of people around the world still lack access to prevention and treatment services that could protect them from these causes of premature death. The authors say countries can make significant gains by publicly subsidizing the costs of essential medicines, diagnostics, vaccines and other interventions that address these 15 conditions. This public subsidy, they argue, should be combined with scaled-up financing of research and innovation to develop new health technologies.

If the "50 by 50" goals are reached by every country, a person born in 2050 would have only a 15 percent chance of dying before age 70, down from 31 percent for someone born in 2019. Among the 37 countries that are on track to reach this benchmark are seven of the world's most populous nations, including Bangladesh, China and Iran.

But such gains are achievable and sustainable across any high-, middle- and low-income country that chooses this path, the report asserts. The authors lay out specific policies and health financing strategies that make it feasible for even the poorest countries to take a cost-effective approach to reducing mortality.

 "Health policy changes people's lives," says Wenhui Mao, Ph.D., a senior policy analyst at Duke University and one of the 50 authors on the commission report. "Without good health policies, populations won't get the health outcome they deserve. Large disparities will continue to occur."

The report calls for increased taxation on tobacco products, unhealthy foods and drinks, and fossil fuels, which the authors say would both reduce illness and death attributable to those products and raise revenue that can be reinvested in health systems. While all these taxes are win-win, the commission's clear message is that by far the highest priority is high taxes on tobacco. The commission points out, for example, that smoking remains one of the biggest causes of preventable mortality in many parts of the world, causing more than 8 million deaths worldwide annually, according to the World Health Organization.

Raising taxes on tobacco may be the single most important health policy in the commission's report, Yamey notes, because of the immediate gains it could create for the world's poorest citizens. "They are the most price sensitive, so they're more likely to quit when tobacco prices rise," he says. "Therefore, they are more likely to get the health and financial benefits of giving up smoking."

Global Health 2050 is the third report released by the commission since its creation in 2013. Chaired by former US Treasury Secretary Lawrence H. Summers, the commission was formed twenty years after the World Bank published a report in 1993, called "Investing in Health," that showed that targeted spending on cost-effective interventions for high-burden diseases could improve health outcomes, boost economies, and improve human welfare. 

Early mortality and early death from diseases is awful for families, communities, economies and countries. You want people living long, healthy, productive lives. We hope this report helps bring focus to this global health agenda."

Gavin Yamey, M.D., Director, Duke University Center for Policy Impact in Global Health (CPIGH)